Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Parent organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other names
NATIONAL TEACHERS ACADEMY CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
MR. HENRY TAYLOR (EXECUTIVE DIRECTOR)
(312) 413-1261
Entity
Organization
Contact information
Practice address
55 W CERMAK RD, CHICAGO, IL 60616-2001
(312) 996-2000
(312) 413-1782
Mailing address
2045 W WASHINGTON BLVD, M/C 698, CHICAGO, IL 60612-2428
(312) 996-2000
(312) 413-1782
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBS PROVIDER ID
—
Enumeration date
07/14/2006
Last updated
11/14/2024
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